Background: The GOELAMS 072 study showed that first-line high-dose chemotherapy (HDT) with peripheral blood stem cell transplant (PBSCT) support was superior to the standard chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine and prednisone; CHOP) in adults with aggressive non-Hodgkin’s lymphoma (NHL).
Objective: The aim of the study was to evaluate the pharmacoeconomic profile of HDT with PBSCT support relative to standard CHOP therapy as first-line treatment in adults with aggressive NHL.
Methods: We performed a cost-effectiveness analysis from the French Public Health Insurance perspective, restricted to hospital costs (€, year 2008 values). The clinical effectiveness criterion was censured overall survival (OS) difference after a median follow-up of 4 years for the entire cohort. A total of 197 patients were included (CHOP, n = 99; HDT, n = 98). Uncertainty was assessed using non-parametric bootstrap simulations and various scenario analyses.
Results: Five-year OS did not differ significantly between groups for the entire cohort. Nevertheless, subgroup analyses appeared to be more relevant for decision making: among patients with a high-intermediate risk according to the age-adjusted International Prognostic Index (IPI), HDT yielded a significantly higher 5-year OS than CHOP (74% vs 44%; p = 0.001). Among these patients, the mean censured OS survival, adjusted for time discounting and quality of life (QOL), increased with HDT by 1.20 years (95% CI 1.19, 1.21). The cost per life-year saved with HDT was estimated as h34 315 (95% CI 32 683, 35 947) in this subgroup.
Conclusion: Results suggested thatHDT with PBSCT supportmight be considered a cost-effective strategy among patients with high-intermediate-risk NHL according to the age-adjusted IPI. Its place and its cost effectiveness potential versus, or in combination with, rituximab still need further research.
Overall Survival Peripheral Blood Stem Cell Transplant Autologous Bone Marrow Transplantation Unit Prex Chop Group
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No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.
The authors would like to thank Michel Lamure, Céline Menat, Fanny Gaillard, Vincent Delwail, Christian Berthou, Rémy Gressin, Jean-Yves Cahn and Virginie Lucas.
Beard SM, Wall L, Gaffney L, et al. Aggressive non-Hodgkin’s lymphoma: economics of high-dose therapy. Pharmacoeconomics 2004; 22: 207–24CrossRefPubMedGoogle Scholar
Philip T, Guglielmi C, Hagenbeek A, et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin’s lymphoma. N Engl J Med 1995; 333: 1540–5CrossRefPubMedGoogle Scholar
Haioun C, Lepage E, Gisselbrecht C, et al. Survival benefit of high-dose therapy in poor-risk aggressive non-Hodgkin’s lymphoma: final analysis of the prospective LNH87–2 protocol. A groupe d’Etude des Lymphomes de l’Adulte study. J Clin Oncol 2000; 18: 3025–30PubMedGoogle Scholar
Coiffier B, Lepage E, Briere J, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002; 346: 235–42CrossRefPubMedGoogle Scholar
Milpied N, Deconinck E, Gaillard F, et al. Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 2004; 350: 1287–95CrossRefPubMedGoogle Scholar
Marie JP, Bisserbe S, Bouaziz C, et al. A program for medical use of information systems: validity of calculation of direct costs for the initial treatment of acute myeloblastic leukaemia [in French]. Presse Med 1992; 21: 1364–8PubMedGoogle Scholar
Borella L, Peuverel P, Sauvage M, et al. A study based on national DRG data to evaluate work load and practice relating to cancer patients in not-for-profit hospitals [in French]. Rev Epidémiol Santé Publique 2000; 48: 53–70PubMedGoogle Scholar
Messori A, Bonistalli L, Costantini M, et al. Cost-effectiveness of autologous bone marrow transplantation in patients with relapsed non-Hodgkin’s lymphoma. Bone Marrow Transplant 1997; 19: 275–81CrossRefPubMedGoogle Scholar
Beard SM, Lorigan PC, Sampson FC. The cost-effectiveness of high dose chemotherapy in the treatment of relapsed Hodgkin’s disease and non-Hodgkin’s lymphoma. Br J Cancer 2000; 82: 81–4CrossRefPubMedGoogle Scholar
Hartmann O, Le Corroller AG, Blaise D, et al. Peripheral blood stem cell and bone marrow transplantation for solid tumors and lymphomas: hematologic recovery and costs. A randomized, controlled trial. Ann Intern Med 1997; 126: 600–7PubMedGoogle Scholar
Smith TJ, Hillner BE, Schmitz N, et al. Economic analysis of a randomized clinical trial to compare filgrastim-mobilized peripheral-blood progenitor-cell transplantation and autologous bone marrow transplantation in patients with Hodgkin’s and non-Hodgkin’s lymphoma. J Clin Oncol 1997; 15: 5–10PubMedGoogle Scholar
van Agthoven M, Vellenga E, Fibbe WE, et al. Cost analysis and quality of life assessment comparing patients undergoing autologous peripheral blood stem cell transplantation or autologous bone marrow transplantation for refractory or relapsed non-Hodgkin’s lymphoma or Hodgkin’s disease: a prospective randomised trial. Eur J Cancer 2001; 37: 1781–9CrossRefPubMedGoogle Scholar
Uyl-de Groot CA, Ossenkoppele GJ, Buijt I, et al. Costs of peripheral blood progenitor cell transplantation using whole blood mobilised by filgrastim as compared with autologous bone marrow transplantation in non-Hodgkin’s lymphoma. Pharmacoeconomics 1999; 15: 305–11CrossRefPubMedGoogle Scholar
Woronoff-Lemsi MC, Arveux P, Limat S, et al. Cost comparative study of autologous peripheral blood progenitor cells (PBPC) and bone marrow (ABM) transplantations for non-Hodgkin’s lymphoma patients. Bone Marrow Transplant 1997; 20: 975–82CrossRefPubMedGoogle Scholar
Hornberger JC, Best JH. Cost utility in the United States of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone for the treatment of elderly patients with diffuse large B-cell lymphoma. Cancer 2005; 103: 1644–51CrossRefPubMedGoogle Scholar
Organisation for Economic Co-operation and Development (OECD). Consumer price indices [online]. Available from URL: http://www.oecd.org [Accessed 2008 Aug 29]
Briggs AH, Wonderling DE, Mooney CZ. Pulling cost-effectiveness analysis up by its bootstraps: a non-parametric approach to confidence interval estimation. Health Econ 1997; 6: 327–40CrossRefPubMedGoogle Scholar
van Agthoven M, Sonneveld P, Verdonck LF, et al. Cost determinants in aggressive non-Hoddgkin’s lymphoma. Haematologica 2005; 90: 661–71PubMedGoogle Scholar
Gelber RD, Gelman RS, Goldhirsch A. Quality of life oriented endpoint for comparing therapies. Biometrics 1989; 45: 781–95CrossRefPubMedGoogle Scholar
Pickard AS, Wilke CT, Lin HW, et al. Health utilities using the EQ-5D in studies of cancer. Pharmacoeconomics 2007; 25: 365–84CrossRefPubMedGoogle Scholar
Doorduijn J, Buijt I, van der Holt B, et al. Self-reported quality of life in elderly patients with aggressive non-Hodgkin’s lymphoma treated with CHOP therapy. Eur J Haematol 2005; 75: 116–23CrossRefPubMedGoogle Scholar
Doorduijn J, Buijt I, Uyl-de Groot C, et al. Quality of life in elderly patients with aggressive non-Hodgkin’s lymphoma (NHL) treated with CHOP. Blood 2001; 98: 430aGoogle Scholar
The EuroQol group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy 1990; 16: 199–208CrossRefGoogle Scholar
Jönsson B. Economics of drug treatment: for which patients is it cost-effective to lower cholesterol? Lancet 2001; 358: 1251–6CrossRefPubMedGoogle Scholar
Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost-utility assessments in oncology. J Clin Oncol 2000; 18: 3302–17PubMedGoogle Scholar
O’Brien BJ, Heyland D, Richardson WS, et al. User’s guides to the medical literature: how to use an article on economic analysis of clinical practice. What are results and will they help me in caring for my patients? JAMA 1997; 277: 1802–8CrossRefPubMedGoogle Scholar
Best JH, Hornberger J, Proctor SJ, et al. Cost-effectiveness analysis of rituximab combined with chop for treatment of diffuse large B-cell lymphoma. Value Health 2005; 8: 462–70CrossRefPubMedGoogle Scholar
Mishra V, Andresen S, Brinch L, et al. Cost of autologous peripheral blood stem cell transplantation: the Norwegian experience from a multicenter cost study. Bone Marrow Transplant 2005; 35: 1149–53CrossRefPubMedGoogle Scholar
Limat S, Woronoff-Lemsi MC, Milpied N, et al. Effect of cell determinant (CD)34+ cell dose on the cost and consequences of peripheral blood stem cell transplantation for non-Hodgkin’s lymphoma patients in front-line therapy. Eur J Cancer 2000; 36: 2360–7CrossRefPubMedGoogle Scholar
Limat S, Woronoff-Lemsi MC, Deconinck E, et al. Cost-effectiveness of CD34+ dose in peripheral blood progenitor cell transplantation for non-Hodgkin’s lymphoma patients: a single centre study. Bone Marrow Transplant 2000; 25: 997–1002CrossRefPubMedGoogle Scholar
Bennett CL, Armitage JL, Armitage GO, et al. Costs of care and outcomes for high-dose therapy and autologous transplantation for lymphoid malignancies: results from the University of Nebraska 1987 through 1991. J Clin Oncol 1995; 13: 969–73PubMedGoogle Scholar
Feugier P, Van Hoof A, Sebban C, et al. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 2005; 23: 4117–26CrossRefPubMedGoogle Scholar